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WVSSAC Sports Physical Form (West Virginia)

West Virginia's WVSSAC requires a participation, parental consent and physician's certificate form, completely filled in, before a student joins any school athletic team. The 2026-27 packet combines eligibility rules and parent consent, the student's medical history, vital signs, a screening physical exam, and concussion and opioid information.

Who completes it

The parent completes the medical history (Part III) and signs the consents, and the student signs Part I. The examiner completes vital signs, the screening exam with PHQ-4 and the recommendation, signing as MD, DO, DC, advanced registered nurse practitioner or physician assistant.

Submitting and payment

How to submit it
The completed form is returned to the school principal before the student becomes a member of any school athletic team.
Who pays
WVSSAC sets no fee and the form does not say who pays for the exam.

Good to know

  • Any yes answer under the cardiovascular findings requires a referral to a family doctor or other appropriate health care provider.
  • Recommendations are full approval, full approval needing further evaluation by a dentist, eye doctor, family physician or other, limited approval with restrictions, or denial with reasons.
  • The member school's team physician decides removal for injury or illness, and return-to-activity clearance rests with that physician or a designated representative.
  • After a concussion, WVSSAC's Return to Play Protocol requires written clearance from an appropriate health care professional; it is a separate protocol sheet, not part of this form.

Get the official form

Download the current version from the source each time; forms change without notice.

WVSSAC Sports Physical Form

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can sign the WVSSAC physical form?

The recommendation section's signature line lists MD, DO, DC, Advanced Registered Nurse Practitioner and Physician's Assistant. The examiner signs and dates it after marking full approval, approval with further evaluation, limited approval with restrictions, or denial.

Is the WVSSAC physical a full checkup?

No. Part V is labeled a screening physical exam, and the form states it is not meant to replace a full physical examination by the student's private physician. It screens mouth, lymph nodes, skin, respiratory, cardiovascular, abdominal and musculoskeletal items with yes or no answers.

Does the WVSSAC physical include a mental health screen?

Yes. The screening exam page includes the four PHQ-4 questions on feeling nervous, being unable to stop worrying, having little interest in doing things and feeling down, each scored from not at all to nearly every day.